Prior Authorization Update - Pharmacy Medical Oncology

Jun. 21, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for specialty drugs used for oncologic application.

Starting October 11, 2021, AIM Specialty Health® (AIM), rather than BCBSMT, will manage prior authorization requests and post service medical necessity reviews for drugs in the Pharmacy Medical Oncology care category for some members.

What’s Not Changing: Healthy Montana Kids (HMK) medical drug applications will continue to be managed by BCBSMT.

Note: AIM will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBSMT.

Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Keep in mind these key dates and scenarios as we transition to AIM:

  • Authorizations initiated with BCBSMT will remain active with BCBSMT until the request expires, including dates before or after October 11, 2021.
  • Contact BCBSMT to extend an active authorization for dates of service prior to October 11, 2021.
  • Contact AIM via the ProviderPortal Learn more about third-party links to extend an active authorization for dates of service on or after October 11, 2021.
  • Contact AIM for all authorizations initiated on and after October 11, 2021. Please use the AIM ProviderPortal for any new requests.
  • Predeterminations will no longer be offered for the Medical Oncology drug care category. All requests will be processed as a prior authorization.
  • AIM’s ProviderPortal Learn more about third-party links and call center will be begin accepting prior authorization requests on Sep. 27, 2021 for dates of service on or after October 11, 2021.
  • Do not submit prior authorization requests for Medical Oncology drug codes to BCBSMT for dates of service on or after October 11, 2021 (Exception: HMK).
  • Continue to submit prior authorization requests to BCBSMT through October 10, 2021, for dates of service before October 11, 2021.

More Information: Refer to the Utilization Management section of our Provider website. The updated Specialty Drug Code list includes the drugs for Medical Oncology that AIM will review starting October 11, 2021. The Speciality Drug Code List is posted here PDF Document.

Find information about our prior authorization program with AIM at this microsite Learn more about third-party links.

Other Important Reminders: Make sure you’re registered with AIM, prior to October 11, 2021.

There are two ways to register:

  • Online – Go to the AIM ProviderPortal Learn more about third-party links; or
  • By Phone – Call the AIM Contact Center at 844-377-1285, Monday through Friday, 7 a.m. to 7 p.m., MT.

Join Us for A Webinar to Learn More: It’s important to attend an online training session for more in-depth information on key dates. You can also get a preview of the AIM ProviderPortal and the Medical Oncology program. Visit the AIM microsite for links to future training dates Learn more about third-party links or register at these links below.

AIM Medical Oncology Training Dates and Times
Wednesday, September 15, 2021 from 1 – 2 p.m. MST Register Learn more about third-party links
Friday, September 24, 2021 from 8 – 9 a.m. MST Register Learn more about third-party links
Tuesday, September 28, 2021 from 11 – noon MST Register Learn more about third-party links
Wednesday, October 6, 2021 from 11 – noon MST Register Learn more about third-party links
Tuesday, October 12, 2021 from 11 – noon MST Register Learn more about third-party links

For More Information: Continue to watch the News and Updates for reminders, announcements and educational resources that will help you transition to submitting commercial prior authorization requests through AIM.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

AIM Specialty Health (AIM) is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as AIM or Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.

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